Provider Demographics
NPI:1932193539
Name:BEL AIR PHYSICAL THERAPY AND SPORTS CLINIC PC
Entity Type:Organization
Organization Name:BEL AIR PHYSICAL THERAPY AND SPORTS CLINIC PC
Other - Org Name:BEL AIR PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:903-677-3600
Mailing Address - Street 1:610A MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3332
Mailing Address - Country:US
Mailing Address - Phone:903-677-3600
Mailing Address - Fax:903-677-1359
Practice Address - Street 1:610A MARYLAND DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3332
Practice Address - Country:US
Practice Address - Phone:903-677-3600
Practice Address - Fax:903-677-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00083XMedicare ID - Type Unspecified